Patient Forms

Save time at the office by filling out your health history information online! Please read through our Privacy Notice PDF below, then click on the link to complete the Health History Form.

Your information will be sent directly to the office with secure encryption. We will already have it when you arrive for your first appointment. All your personal health information is confidential, and will not be shared with anyone, aside from those involved in your treatment, without your consent.

If you’re unable to open PDF files, you can get Adobe Reader® for free.

We Offer Automatic Payments

 

You will benefit in the following ways with any method you choose:

  • Convenience – Since payments are due once a month and treatment is scheduled less frequently, you do not have to remember to mail in your payment.
  • No Late Fees – With today’s busy schedules, avoid a late fee.
  • Save Time and Money – No stamps, no envelopes and no hassle
  • No Additional Cost to You!

To enroll, simply complete and sign the authorization below and return it to our office, or call our office manager, Julie, at (425) 453-0551

  • Automated Payment Authorization Form — PDF

If you’re unable to open PDF files, you can get Adobe Reader® for free.

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